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May 1986, Vol 140, No. 5 >
Article | May 1986

Hypercapnea and Hypoxia Challenge Tests in Infants at Risk for Sudden Infant Death Syndrome FREE

Jeffrey A. Lindenberg, MD; James D. Newcomb
[+] Author Affiliations

Accepted for publication Feb 3, 1986.

Reprint requests to San Joaquin General Hospital, PO Box 1020, Stockton, CA 95201 (Dr Lindenberg).


Am J Dis Child. 1986;140(5):466-470. doi:10.1001/archpedi.1986.02140190076030.
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• Infants who have almost died of sudden infant death syndrome (SIDS) and infants who are siblings of SIDS victims constitute groups at increased risk for SIDS. Management dilemmas are common among physicians caring for these infants. To assess the usefulness of hypoxia (17% oxygen) and hypercapnea (3% carbon dioxide) challenge tests as predictors of outcome, we reviewed the records of 102 infants who underwent these tests. During hypoxia tests, we found that periodic breathing and respiratory pauses frequently developed among the infants in these high-risk groups, but also developed among control infants. During hypercapnea testing, some infants failed to increase their minute ventilation (usually measured by volume of breath × breaths per minute), but control infants showed this poor response just as often as high-risk infants. Our findings suggest that hypoxia and hypercapnea stress tests are of limited usefulness in planning management of infants at risk for SIDS.

(AJDC 1986;140:466-470)

REFERENCES

1 +
Valdez-Dapena M:  Sudden infant death syndrome: A review of the medical literature 1974-1979 . Pediatrics 1980;;66:597-614.
2 +
Merritt A, Valdez-Dapena M:  SIDS research update . Pediatr Annu 1984;;13:193-207.
3 +
Yount JE, Flanagan WJ, Bingley EF:  Evidence of an exponentially increasing incidence of sudden infant death syndrome (SIDS) with decreasing birth weight (BW) . Pediatr Res 1979;;13:510.
4 +
Standfast SJ, Aliferis D, Janerich DT:  Epidemiology of SIDS in upstate New York , in Tildow JT, Roeder LM, Steinschneider A (eds): Sudden Infant Death Syndrome . New York, Academic Press Inc, 1983;, pp 59-75.
5 +
Peterson DR, Chin NM, Fisher LD:  The sudden infant death syndrome: Repetitions in families . J Pediatr 1980;;97:265-267.
6 +
Irgens LM, Skjaerven R, Peterson DR:  Prospective assessment of recurrence risk in sudden infant death syndrome siblings . J Pediatr 1984;;104:349-351.
7 +
Ariagno R, Guilleminault C, Korobkin R, et al:  'Near-miss' for sudden infant death syndrome infants: A clinical problem . Pediatrics 1983;;71:726-730.
8 +
Duffty P, Bryan MH:  Home apnea monitoring in 'near-miss' sudden infant death syndrome (SIDS) and in siblings of SIDS victims . Pediatrics 1982;;70:69-74.
9 +
Steinschneider A:  Prolonged apnea and the sudden infant death syndrome: Clinical and laboratory observations . Pediatrics 1972;;50:646-655.
10 +
Ariagno RL:  Evaluation and management of infantile apnea . Pediatr Annu 1984;;13:210-217.
11 +
Durand M, Cabal LA, Gonzalez F, et al:  Ventilatory control and carbon dioxide response in preterm infants with idiopathic apnea . AJDC 1985;;139:717-720.
12 +
Kelly DH, Shannon DC:  Periodic breathing in infants with near-miss sudden infant death syndrome . Pediatrics 1979;;63:355-360.
13 +
Shannon DC, Kelly DH, O'Connell K:  Abnormal regulation of ventilation in infants at risk for sudden infant death syndrome . N Engl J Med 1977;;297:747-750.
14 +
Brady JP, Chir B, McCann EM:  Control of ventilation in subsequent siblings of victims of sudden death syndrome . J Pediatr 1985;;106: 212-217.
15 +
Hunt CE:  Abnormal hypercarbic and hypoxic sleep arousal responses in near-miss SIDS infants . Pediatr Res 1981;;15:1462-1464.
16 +
Van der Hal AL, Sargeant CW, Platzker AC, et al:  Hypoxic and hypercapnic arousal responses do not predict subsequent apneas in near-miss sudden infant death syndrome . Am Rev Respir Dis 1982;;125:186.
17 +
Ariagno R, Nagel L, Guilleminault C:  Waking and ventilatory responses during sleep in infants near-miss for sudden infant death syndrome . Sleep 1980;;3:351-359.
18 +
Lees MH, Newcomb JD, Laats SA:  A simple method of measuring the ventilatory response to carbon dioxide in the evaluation of infant apnea . Perinatol Neonatol 1983;;9:42-53.
19 +
Ariagno RL:  Developoment of respiratory control , in Korobkin R, Guilleminault C (eds): Advances in Perinatal Neurology . Jamaica, NY, SP Medical & Scientific Books, 1979;, vol 1, pp 249-280.
20 +
Lees MN, Olsen GD, McGilliard KL:  Chloral hydrate and the carbon dioxide chemoreceptor response: A study of puppies and infants . Pediatrics 1982;;70:447-450.
21 +
Hunt CE, Hazenski TA, Gora P:  Experimental effects of chloral hydrate on ventilatory response to hypoxia and hypercarbia . Pediatr Res 1982;;16:79-81.
22 +
Lees MH, Burnell RH, Morgan CL:  Ventilation-perfusion relationships in children with heart disease and diminished pulmonary blood flow . Pediatrics 1968;;42:778-785.
23 +
Brady JP, Durand M, McCann E:  A simple method for estimating the ventilatory response to CO2 in infants . Am Rev Respir Dis 1983;;127: 422-424.
24 +
Rigatto H, de la Torre Verduzco R, Cates DB:  Effects of O2 on the ventilatory response to CO2 in preterm infants . J Appl Physiol 1975;;39: 896-899.
25 +
Zar JH: Biostatistical Analysis . Englewood Cliffs, NJ, Prentice-Hall Inc, 1974;, p 155.
26 +
Daily WJ, Klaus M, Meyer HB:  Apnea in premature infants: Monitoring, incidence, heart rate changes, and an effect of environmental temperature . Pediatrics 1969;;43:510-518.
27 +
Kelly DH, Walker AM, Cahen L, et al:  Periodic breathing in siblings of sudden infant death syndrome . Pediatrics 1980;;66:515-520.
28 +
Southall DP, Richards JM, deSwiet M, et al:  Identification of infants destined to die unexpectedly during infancy: Evaluation of predictive importance of prolonged apnea and disorders of cardiac rhythm or conduction: First report of a multicentered prospective study into the sudden infant death syndrome . Br Med J 1983;; 286:1092-1096.
29 +
Avery ME, Frantz ID III:  To breathe or not to breathe: What have we learned about apneic spells and sudden infant death? N Engl J Med 1983;;309:107-108.

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References

1 +
Valdez-Dapena M:  Sudden infant death syndrome: A review of the medical literature 1974-1979 . Pediatrics 1980;;66:597-614.
2 +
Merritt A, Valdez-Dapena M:  SIDS research update . Pediatr Annu 1984;;13:193-207.
3 +
Yount JE, Flanagan WJ, Bingley EF:  Evidence of an exponentially increasing incidence of sudden infant death syndrome (SIDS) with decreasing birth weight (BW) . Pediatr Res 1979;;13:510.
4 +
Standfast SJ, Aliferis D, Janerich DT:  Epidemiology of SIDS in upstate New York , in Tildow JT, Roeder LM, Steinschneider A (eds): Sudden Infant Death Syndrome . New York, Academic Press Inc, 1983;, pp 59-75.
5 +
Peterson DR, Chin NM, Fisher LD:  The sudden infant death syndrome: Repetitions in families . J Pediatr 1980;;97:265-267.
6 +
Irgens LM, Skjaerven R, Peterson DR:  Prospective assessment of recurrence risk in sudden infant death syndrome siblings . J Pediatr 1984;;104:349-351.
7 +
Ariagno R, Guilleminault C, Korobkin R, et al:  'Near-miss' for sudden infant death syndrome infants: A clinical problem . Pediatrics 1983;;71:726-730.
8 +
Duffty P, Bryan MH:  Home apnea monitoring in 'near-miss' sudden infant death syndrome (SIDS) and in siblings of SIDS victims . Pediatrics 1982;;70:69-74.
9 +
Steinschneider A:  Prolonged apnea and the sudden infant death syndrome: Clinical and laboratory observations . Pediatrics 1972;;50:646-655.
10 +
Ariagno RL:  Evaluation and management of infantile apnea . Pediatr Annu 1984;;13:210-217.
11 +
Durand M, Cabal LA, Gonzalez F, et al:  Ventilatory control and carbon dioxide response in preterm infants with idiopathic apnea . AJDC 1985;;139:717-720.
12 +
Kelly DH, Shannon DC:  Periodic breathing in infants with near-miss sudden infant death syndrome . Pediatrics 1979;;63:355-360.
13 +
Shannon DC, Kelly DH, O'Connell K:  Abnormal regulation of ventilation in infants at risk for sudden infant death syndrome . N Engl J Med 1977;;297:747-750.
14 +
Brady JP, Chir B, McCann EM:  Control of ventilation in subsequent siblings of victims of sudden death syndrome . J Pediatr 1985;;106: 212-217.
15 +
Hunt CE:  Abnormal hypercarbic and hypoxic sleep arousal responses in near-miss SIDS infants . Pediatr Res 1981;;15:1462-1464.
16 +
Van der Hal AL, Sargeant CW, Platzker AC, et al:  Hypoxic and hypercapnic arousal responses do not predict subsequent apneas in near-miss sudden infant death syndrome . Am Rev Respir Dis 1982;;125:186.
17 +
Ariagno R, Nagel L, Guilleminault C:  Waking and ventilatory responses during sleep in infants near-miss for sudden infant death syndrome . Sleep 1980;;3:351-359.
18 +
Lees MH, Newcomb JD, Laats SA:  A simple method of measuring the ventilatory response to carbon dioxide in the evaluation of infant apnea . Perinatol Neonatol 1983;;9:42-53.
19 +
Ariagno RL:  Developoment of respiratory control , in Korobkin R, Guilleminault C (eds): Advances in Perinatal Neurology . Jamaica, NY, SP Medical & Scientific Books, 1979;, vol 1, pp 249-280.
20 +
Lees MN, Olsen GD, McGilliard KL:  Chloral hydrate and the carbon dioxide chemoreceptor response: A study of puppies and infants . Pediatrics 1982;;70:447-450.
21 +
Hunt CE, Hazenski TA, Gora P:  Experimental effects of chloral hydrate on ventilatory response to hypoxia and hypercarbia . Pediatr Res 1982;;16:79-81.
22 +
Lees MH, Burnell RH, Morgan CL:  Ventilation-perfusion relationships in children with heart disease and diminished pulmonary blood flow . Pediatrics 1968;;42:778-785.
23 +
Brady JP, Durand M, McCann E:  A simple method for estimating the ventilatory response to CO2 in infants . Am Rev Respir Dis 1983;;127: 422-424.
24 +
Rigatto H, de la Torre Verduzco R, Cates DB:  Effects of O2 on the ventilatory response to CO2 in preterm infants . J Appl Physiol 1975;;39: 896-899.
25 +
Zar JH: Biostatistical Analysis . Englewood Cliffs, NJ, Prentice-Hall Inc, 1974;, p 155.
26 +
Daily WJ, Klaus M, Meyer HB:  Apnea in premature infants: Monitoring, incidence, heart rate changes, and an effect of environmental temperature . Pediatrics 1969;;43:510-518.
27 +
Kelly DH, Walker AM, Cahen L, et al:  Periodic breathing in siblings of sudden infant death syndrome . Pediatrics 1980;;66:515-520.
28 +
Southall DP, Richards JM, deSwiet M, et al:  Identification of infants destined to die unexpectedly during infancy: Evaluation of predictive importance of prolonged apnea and disorders of cardiac rhythm or conduction: First report of a multicentered prospective study into the sudden infant death syndrome . Br Med J 1983;; 286:1092-1096.
29 +
Avery ME, Frantz ID III:  To breathe or not to breathe: What have we learned about apneic spells and sudden infant death? N Engl J Med 1983;;309:107-108.

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